Appendix N: Exam Petition

MOBERLY AREA COMMUNITY COLLEGE - HEALTH SCIENCE
STUDENT EXAM MAKE-UP PETITION FORM

Student Section: Students need to fill out this portion of the form. This petition must be submitted within one week of the exam or exam closing and presented at the next ADN faculty meeting.

I, _________________________________, wish to petition the nursing faculty of Moberly Area Community College to schedule a make-up exam test date for the following exam, _____________________, given on the following date of my absence, ________________________.

My expected date of graduation is: ________________________.

I was absent due to the reason(s) outlined below, and supporting evidence accompanies this petition.

________________________________________________________________________________

Faculty Section: Faculty to complete this section of the form. ADN instructors submit a copy to the Health Science Director, the student, and place a copy in the student’s file. PN instructors submit a copy to the Practical Nursing Coordinator, the student, and place a copy in the student’s file.
We, the faculty, after careful consideration, have determined the student:

_____May take a makeup exam on ____________; the student will receive a _______% deduction based on

________________________________________________________________________________

Faculty Signatures

Health Sciences Dean/Director: ____________________________________________________

PN Coordinator: __________________________________________________________________

ADN Coordinator: _________________________________________________________________

Student Signature: ________________________________________________________________

Date: ___________________________________________________________________________